EVIDENCE BASED AYURVEDIC

TREATMENT PROTOCOL FOR THE

PATIENTS OF ULCERATIVE COLITIS

Dr. Manish V. Patel

M.D.(Ayu); Ph.D.
Professor, Department of Kāyacikitsā (P.G.)
J. S. Ayurveda College & P D Patel Ayurveda Hospital,
Nadiad – 387001 (India)
• One of the IBD with unknown cause

• Negatively influencing every aspect of

the patient’s life

• Incidence & prevalence is low in India

but increasing day by day

• On the global level, >1 million

Burisch J et.al. (2013) J Crohns Colitis. 7(4):322-37
World J Gastroenterol. 2016 Sep 28; 22(36): 8123–8136.
NO. OF NEW CASES & EXISTING CASES
IN 100 THOUSAND POPULATION

19.2 & From 79 to &

24.3
493 in last 15
249 years 505 6.3 &
114

11.2 &
145
World Gastroenterology Organisation Global Guidelines (August 2015); Page 3.
 ULCERATIVE COLITIS ACCORDING TO
AYURVEDA
Signs/symptoms Doṣa Aṁśāṁśa Duṣya Srotas
Frequency of stool Vāta Cala Purīṣa Purīṣavaha

Liquid stool Pitta Drava, sara Purīṣa, udaka Purīṣavaha

Bleeding in stool Pitta Uṣṇa, tikṣṇa Purīṣa, rakta Purīṣa & raktavaha

Excessive thirst Pitta Uṣṇa Udaka Udakavaha

Abdominal pain Vāta Śīta Purīṣa & annavaha

Burning sensation Pitta Uṣṇa Purīṣa & annavaha

General weakness Vāta Laghu Rasa Rasavaha

Loss of appetite Kapha Guru, Śīta Rasa Annavaha

Fever Pitta Uṣṇa Rasa, sveda Rasa & svedavaha

 INFLAMMATION Pitta dominating tridoṣa

Rakta and purīṣa as duṣya

ULCERS IN COLON
Purīṣavaha srotas

Usṇa, tikṣṇa, sara and

Bleeding Hyperactivity drava guṇa of pitta
and irritability
H2O Dhātū kṣaya (Loss of
absorption Peristaltic
movement
rakta, rasa and udaka)
Fluid in colon
Increase vāta

Advanced stage of
Pittatisara RAKTĀTĪSRA
ULCERATIVE COLITIS
Pitta vitiating food and lifestyle
Unknown cause (with or without pittātīsāra)
 STANDARD AYURVEDIC TREATMENT
GUIDELINE

Principles of Management (Cikitsā Siddhānta)

• Reduce the frequency by using the grāhī

auṣadha (Ayurvedic astringents)

• Raktastambhaka auṣadha (Hemostatic ayurvedic

remedies)

• Avoid medicines having uṣṇa and tikṣṇa

properties even they are grāhī or raktastambhaka
• Basti karma (procto-colonic administration of
ayurvedic medicines)

• Harmonizing mānasbhāvāḥ (psychological

factors)

• Integrative medicine approach

➢ Patients of acute and severe condition
➢ Who are taking conventional medicines especially
immuno-suppressants and cortico-steroids

• Special treatment according to the clinical

stages
Treatment plan – A
• < 10 stool frequency • Blood in less quantity
• < 5 frequency have blood • Less/no colon irritability
• Remission period
1. Lodhra 1 g + Mustā 2 g + Nāgakeśara 1 g / 3 times

2. Udumbara kvātha 40 ml twice

3. Kuṭaja ghana vaṭī 3 tablets (500 mg each) 3 times

4. Vatsakādi vaṭī 2 tablets (500 mg each) 3 times

5. Udumbara kvātha basti 100 ml after the lunch

Treatment plan – B
• ≥ 10 stool frequency • Blood in large quantity
• ≥ 5 frequency have blood • More colon irritability
• Acute and severe case

Add one or more with plan A

• Jātiphala cūrṇa 500 mg to 1 g three times

• Gaṅgādhara cūrṇa 3 g three times
• Increase dose of kuṭaja ghana vaṭī as 4 tab 3
to 4 times in a day
• Karpura rasa (rasa preparation) 1 tablet of 125
mg 2 to 3 times in a day
 Treatment plan – C
Āvasthikī cikitsā (treatment according to various
condition or clinical stages)

1. Frequently voids little amount of stool and

blood; gripping abdominal pain; ↑ vāta in colon
➢ Picchābasti after the lunch

Goat milk 100 ml +

water 100 ml +
mocarasa cūrṇa 10 g
boiled till 100 ml
liquid remains
Secretion of Salmalia
Malabarica
2. Abdominal pain during or just before the stool;
Dull abdominal pain whole day; Hard stool or
difficult to pass the stool; ↑ vāta in colon

➢ Jātyāditaila mātrābasti 40 ml after the dinner

3. Burning sensations in body or in abdomen;

↑Pitta

➢ Muktāpañcāmṛta rasa (rasa preparation) 250

mg three times
4. Perianal abscess; Burning sensation/fissure
in anus

➢ Local application of udumbara kvātha

+ jātyāditaila / jātyāditaila alone

5. Excessive burning sensation in abdomen/

rectum; Chronic condition; General debility;
Who has normal or good agni; ↑ Pitta and vāta

➢ Śatāvarī ghṛta (medicated ghee made from

cow ghee, śatāvarī and milk) 20 ml twice
6. Excessive anxiety, mental stress; lake of sleep
➢ Brāhmī ghṛta nasya 6-8 drops and/or
➢ Tagarādī vaṭī – 2 tablets (500 mg) twice
➢ Muktāpañcāmṛta rasa 250 mg three times

7. Joint pain, coughing, sore throat

➢ Sallakī 400 mg three times for sucking

8. After one month of hospitalized treatment

➢ Treated with oral medicine at home
➢ Regular check-up at every month
 USEFUL DIET AND LIFESTYLE
Items Pathya (useful)
Grains Old rice, brown rice
Beans Green gram (mudga), Lintel (masūra)
Vegetables white gourd, bottle gourd/pumpkin, ridge gourd,
(cooked only) asparagus, potatoes, zucchini, cucumber, sweet
potatoes
Fruits Pomegranates, sweet apple, ripe banana
Spices Cardamom, cloves, saffron, fennel, dry coriander
seeds, turmeric powder, cumin, rock salts (limited)
Milk/milk Goat milk or fresh churned yogurt preferably of
products goat milk
Ghee Cow ghee when diarrhea is in control
Lifestyle Sadvṛtta (good conduct), meditation
• Patients of ulcerative colitis in P D Patel
Ayurveda Hospital, Nadiad from 2007 to 2015

64
88
COMPELETED > 1 year
112 follow-up
ACTIVE
140 NEW 24 LAMA
PATIENS
28 TREATED
REMISSION IN OPD
CHANGES IN MEANSCORE OF SYMPTOMS IN
88 PATIENTS OF ULCERATIVE COLITIS

12

10
P < 0.001
8 11.34
Mean score
6
8.62 Initial
Mean score
4 After 1 month
4.06 Mean score
2 3.18 After 6 months
2.15
0
0
Bowel frequency Stool frequency
(n=88) contains blood (n=88)
CHANGES IN MEANSCORE OF SYMPTOMS IN
88 PATIENTS OF ULCERATIVE COLITIS

2.5

2.42
2 2.3
Mean score
1.5 Initial

Mean score
1 1.15 After 1 month

0.5
0.82 Mean score
0.58 0.78 After 6 months
0 0.11 0
0
Bleeding in Abdominal Weakness
stool (n=88) pain (n=57) (n=68)
CHANGES IN MEANSCORE OF BODY WEIGHT
(in Kg)

54.5

54
54.12
53.5

53 53.47

52.5
52.32
52

51.5

51
Initial After 1 month After 6 months
 IMPROVEMENT IN HEMOGLOBIN VALUE
(In gm%)
12
P < 0.01
10
10.96
8 9.69
6 7.93
4

0
Initial After 1 month After 6 months
Mean score
 CHANGES FOUND IN STOOL MICROSCOPY
Grade score 0 1 2 3 4
RBCs/Puss Nil Less than 16-30/hpf 31-50/hpf Plenty/more
cells in stool 15/hpf than 50/hpf

2.5

P < 0.05
2
2.14
1.76 Mean score
1.5 Initial

Mean score
After 1 month
1
Mean score
After 6 months
0.5

0.1 0.22 0.18

0
0
RBCs in stool (/hpf) Pus cells in stool (/hpf)
 NUMBER OF PATIENTS SHOWN OCCULT
BLOOD IN THE STOOL

100

80
88
60

40

20
7 0
0
Initial After 1 month After 6 months
NO. OF PATIENTS FOUND
 REDUCTION OF DOSE OF CONVENTIONAL
MEDICINE

14

12
12.46
10
Mean score
8
Initial
6 Mean score
After 1 month
4
Mean score
2 2.74 After 6
0.4 0 0 0 months
0
mesalamine sulfate Prednisolone (mg/day)
(g/day)
Research articles published / presented
in international peer review journals /
seminars
• Effects of Ayurvedic treatment on forty-three patients of ulcerative
colitis. AYU, 2010; 3(4): 478-481.
Available http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3202252/

• Ayurvedic management of ulcerative colitis: a non-randomized

observational clinical study. Forsch Komplementmed
2013; 20:144-147. DOI:10.1159/000350832.

• Ayurvedic management of ulcerative colitis – poster presented at

International Research Congress for Integrative Medicine and
Health (IRCIMH), held at Portland, USA on 15-18 May 2012.

• Article published in BMC

Complementary and
Alternative Medicine 2012 12(Suppl 1):P143
DOI: 10.1186/1472-6882-12-S1-P143
I WISH YOU A HEALTHY LIFE WITH REGULAR
HEALTHY BOWEL EVACUATION